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     First Name:        Last Name:        Title:   

     School Name:         Department:   

     School Tax ID Number:       


     Street Address:         City:      

     State/Province:         Zip/Postal Code:         Country:   

     Telephone:         Fax:         E-mail:  

Quintessence Publishing USA will provide resources to instructors in the US and Canada.
Instructors in the rest of the world should contact their nearest Quintessence office.


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